Sarah Smith is a 28-year-old African American female who presents with a wound on her left foot that has been draining pus and causing generalized aches over the past day. She has type 2 diabetes that is not well controlled. On examination, she has a 4 cm infected wound on her foot with surrounding redness, elevated blood glucose, and wheezing. Key concerns are infection of the foot wound given her diabetes and possible pneumonia. Diagnostic testing should include x-rays to check for osteomyelitis and bone involvement from the infection as well as lab work to further evaluate her diabetes and check for other infections or illnesses. Treatment involves antibiotics, wound care, glucose control, and monitoring for spreading infection or

1. Assignment: Sarah Smith Case Study
Assignment: Sarah Smith Case StudyAssignment: Sarah Smith Case StudyFor this
assignment you will be given a case study about a young lady named Sarah Smith. Review
the information provided and answer the questions following. Be sure to cite your
references. Look at Sarah as if she is a patient in your office seeking care. What are your
immediate concerns? What needs to be done for her? Be thorough and succinct in your
responses.Case Study:Sarah Smith is a 28 y/o African American female who presents to the
office with c/o wound to her left foot for the past few days. States she had tripped and fell
while barefoot scraping the top of her foot on the pavement. She denies any other injury
from the incident. Over the past 24 hours the wound has had “smelly” drainage. Has been
experiencing generalized achiness, but denies fever and chills. Did not seek medical
attention at the time of injury. Has been using hydrogen peroxide to clean her wound. Is
unclear of her last tetanus vaccination. Patient PMHx significant for DM II. States that she
takes her medications when she remembers, and does not always check her blood
sugar.PMHx:Asthma: no hospitalizations for exacerbation.DM IIPSHx:DeniesSHx:Former
tobacco user: ceased smoking 2 years ago. Had smoked 1ppd x 5 yearsETOH: sociallyIllicit
drugs: deniesFHx:Significant for paternal DM, otherwise
unremarkableMedications:Metformin: 500mg BID po – did not take the last few
daysAlbuterol MDI: 2 puffs every 6 hours prn – last use just PTASingulair: 10mg po
dailyTrinessa: 1 tab po daily – last taken this amAllergies:PCN: hivesLNMP: 2 weeks
ago.G0p0ROS:General: denies any weight changes, fatigue or fever; + body achesSkin:
denies any rashes; + wound to left footHEENT: denies headache, head injury, dizziness,
lightheadedness; Assignment: Sarah Smith Case StudyDenies any vision changesDenies any
hearing changes, tinnitus, vertigo, earacheORDER NOW FOR CUSTOMIZED, PLAGIARISM-
FREE PAPERSDenies any nasal congestion, discharge, nose bleeds or sinus
tendernessDenies any sore throat, difficulty swallowingNeck: denies any swollen glands,
painBreasts: denies any pain, dischargeRespiratory: denies any dyspnea; positive cough and
wheezingCV: denies any chest pain, edemaGI: denies any
nausea/vomiting/diarrhea/constipation; denies bloody stoolsPV: denies claudication,
swelling to LEGU: denies frequency, urgency, burning;Denies vaginal discharge, itching,
soresDenies penile discharge, itching or soresMS: positive pain to left footPsych: denies
nervousness, depressionNeuro: denies Headache, dizziness, vertigo, syncope, weakness; +
numbness to right LEHeme: denies any easy bruisingPhysical Exam:Vital signs: 100.5
(tympanic), 162/88, 118, 22, O2 sat 95% on RAHeight: 5’5” Weight: 250 lbs.Blood

2. glucose: 230 (Fasting; states has not eaten yet today)patient awake, alert, oriented x 4 in
NADSkin: warm, dry, color WNL. 4 cm lesion noted to anterior left foot with crusting and
purulent drng; + surrounding erythema extending up 7 cm proximallyHEENT: head
nontraumatic, normocephalicPupils PERRLA, EOMs intact; disc margins sharp, without
hemorrhages, exudates; no AV nicking notedEars: bilateral TM with good cone of light and
intactNose: mucosa pink, septum midline; no sinus tenderness appreciatedMouth: mucosa
pink, moist; tongue midline; tonsils 1+ without exudateNeck: supple; trachea midline; no
LADResp: regular and unlabored; lungs with end expiratory wheezing throughoutCV: RRR,
S1 and S2 noted; no s3, s4 or murmur appreciatedAbdomen: soft, non-distended; Bs + x 4;
no tenderness with palpation; no CVA tenderness with percussionGenitalia: deferredRectal:
deferredExtremities: warm and without edema; calves supple, non-tenderPV: no LE
edemaMS: + swelling to left foot; + tenderness of 2-4th left metatarsals; + left pedal pulse;
CMS intact; Cap refill < 2 sec.Neuro: alert, cooperative; thought coherent; oriented x 4;
cranial nerves II-XII intactQuestions:1. List your differentials for her current problems.
Remember you should have at least three different differentials for each problem. Include
rationale for each differential.2. At this time what medical diagnoses are you most
concerned about? Do they impact other diagnoses? If so, how?3. What diagnostic images
would you order? Provide your rationale. What are you trying to rule in or out?4. What
laboratory work would you order? What would you anticipate to be abnormal? Provide
your rationale for each.5. What is your comprehensive plan of care? Include your
rationales.To view the Grading Rubric for this Assignment, please visit the Grading Rubrics
section of the Course Resources.Assignment RequirementsBefore finalizing your work, you
should:be sure to read the Assignment description carefully (as displayed above)consult the
Grading Rubric to make sure you have included everything necessary; andutilize spelling
and grammar check to minimize errors.Your writing Assignment should:follow the
conventions of Standard English (correct grammar, punctuation, etc.);be well ordered,
logical, and unified, as well as original and insightful;display superior content, organization,
style, and mechanics; and